Simultaneous liver and kidney transplantation using donation after cardiac death donors: a brief report

Although the use of donation after cardiac death (DCD) donor organs has been shown to be a viable option for liver and kidney transplant recipients, outcomes after simultaneous liver and kidney (SLK) transplantation using DCD donors are less clear. We performed a retrospective analysis of 37 adult, primary SLK transplants performed at our center between January 1, 1998 and December 31, 2008. Thirty-two patients received donation after brain death (DBD) organs, and 5 patients received DCD organs. SLK recipients in the 2 groups were similar with respect to age, gender, race, body mass index, donor race, and donor body mass index. The calculated Model for End-Stage Liver Disease scores and pretransplant glomerular filtration rates were similar between the groups. DCD donors were younger and had shorter liver cold ischemia times. The median DCD donor warm ischemia time was 19.0 minutes (6.0-25.0 minutes). The recipient surgical times and hospital lengths of stay were comparable between the groups. Delayed graft function was more frequent in DCD renal allografts (80% versus 31%, P = 0.06). The 1-year graft survival rates for liver allografts (100% for the DCD group versus 94% for the DBD group) and kidney allografts (100% for the DCD group versus 94% for the DBD group) were similar. In conclusion, patients undergoing DCD SLK transplantation have comparable 1-year patient and graft survival rates and acceptable perioperative morbidity in comparison with DBD SLK transplant recipients. Although long-term outcomes remain unknown, the utilization of DCD organs for SLK transplantation should be considered a valid approach to safely expanding the donor organ pool.