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Donation after cardiac death liver transplantation: predictors of outcome
A K Mathur1, J Heimbach, D E Steffick
1Section of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. amitmath@med.umich.edu
Insights
Donation after cardiac death (DCD) liver transplantation outcomes show that older recipients, certain races, and longer cold ischemia times increase graft failure and mortality risks. These factors are crucial for refining DCD liver acceptance protocols.
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Donation
Background:
- Donation after cardiac death (DCD) liver transplantation is a growing source of organs.
- Identifying risk factors for graft failure and patient mortality is essential for optimizing outcomes.
Purpose of the Study:
- To identify recipient, donor, and transplant-related risk factors for graft failure and patient mortality after DCD liver transplantation.
- To provide data to aid in the development of DCD liver acceptance protocols.
Main Methods:
- Analysis of Scientific Registry of Transplant Recipients data for US liver-only DCD recipients (September 1, 2001 - April 30, 2009).
- Utilized Cox regression techniques to identify significant risk factors.
- Study cohort included 1567 DCD liver transplant recipients.
Main Results:
- Three-year outcomes: 64.9% alive with functioning graft, 13.6% retransplanted, 21.6% died.
- Graft failure predictors: recipient age ≥ 55, male sex, African-American race, HCV positivity, metabolic liver disorder, high MELD score, hospitalization, and life support.
- Donor factors for graft failure: age ≥ 50, weight >100 kg, increased cold ischemia time (CIT), and warm ischemia time ≥ 35 min.
- Mortality predictors: recipient age ≥ 55, hospitalization, retransplantation, donor weight >100 kg, and CIT.
Conclusions:
- Recipient age, race, pre-transplant status, and donor factors including age, weight, and ischemia times significantly impact DCD liver transplant outcomes.
- Findings support the refinement of donor selection and acceptance criteria for DCD liver transplantation to improve patient and graft survival.
Abstract:
We aimed to identify recipient, donor and transplant risk factors associated with graft failure and patient mortality following donation after cardiac death (DCD) liver transplantation. These estimates were derived from Scientific Registry of Transplant Recipients data from all US liver-only DCD recipients between September 1, 2001 and April 30, 2009 (n = 1567) and Cox regression techniques. Three years post-DCD liver transplant, 64.9% of recipients were alive with functioning grafts, 13.6% required retransplant and 21.6% died. Significant recipient factors predictive of graft failure included: age ≥ 55 years, male sex, African-American race, HCV positivity, metabolic liver disorder, transplant MELD ≥ 35, hospitalization at transplant and the need for life support at transplant (all, p ≤ 0.05). Donor characteristics included age ≥ 50 years and weight >100 kg (all, p ≤ 0.005). Each hour increase in cold ischemia time (CIT) was associated with 6% higher graft failure rate (HR 1.06, p < 0.001). Donor warm ischemia time ≥ 35 min significantly increased graft failure rates (HR 1.84, p = 0.002). Recipient predictors of mortality were age ≥ 55 years, hospitalization at transplant and retransplantation (all, p ≤ 0.006). Donor weight >100 kg and CIT also increased patient mortality (all, p ≤ 0.035). These findings are useful for transplant surgeons creating DCD liver acceptance protocols.
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