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Perioperative complications in liver transplantation using donation after cardiac death grafts: a propensity-matched
Xiongxiong Pan1, Worapot Apinyachon, Wei Xia
1Departments of Anesthesiology and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Insights
Donation after cardiac death (DCD) liver transplants show increased risks of hyperkalemia and postreperfusion syndrome (PRS). Prophylactic measures are recommended for DCD liver grafts to mitigate these complications.
Area of Science:
- Transplantation Surgery
- Organ Donation
- Hepatology
Background:
- Donation after cardiac death (DCD) expands the donor pool for liver transplantation (LT).
- Long-term outcomes of DCD liver grafts are known, but perioperative complications are underreported.
- DCD grafts are crucial for addressing the shortage of organs for liver transplantation.
Purpose of the Study:
- To investigate if DCD grafts are associated with increased postreperfusion complications and worse outcomes in adult LT.
- To compare perioperative complications between DCD and donation after brain death (DBD) liver grafts.
- To identify specific risks associated with DCD liver grafts during the perioperative period.
Main Methods:
- Retrospective review of adult LT patients from 2004-2011.
- Comparison of postreperfusion complications and outcomes between DCD and DBD graft recipients.
- Propensity matching to adjust for differences in preoperative, prereperfusion, and donor variables.
Main Results:
- Postmatching analysis revealed no significant differences in blood product use, vasopressor needs, ventilation times, acute kidney injury, or 30-day/1-year survival rates.
- DCD graft recipients showed significantly higher rates of hyperkalemia (33.8% vs 18.9%) and postreperfusion syndrome (PRS) (25.7% vs 12.3%).
- Propensity matching confirmed that DCD grafts were an independent risk factor for hyperkalemia and PRS.
Conclusions:
- After risk adjustment, DCD liver grafts are associated with increased hyperkalemia and PRS.
- A prophylactic strategy is recommended for managing DCD liver grafts to reduce postreperfusion complications.
- DCD grafts can be safely used, but careful perioperative management is essential to mitigate specific risks.
Abstract:
Donation after cardiac death (DCD) is an important source for expanding the donor pool for liver transplantation (LT). Although the long-term outcomes of LT using DCD grafts have been extensively studied, perioperative complications related to DCD grafts are rarely reported. The aim of this study was to determine whether DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed. Postreperfusion complications and posttransplant outcomes were compared between patients receiving DCD grafts and patients receiving donation after brain death (DBD) grafts. In all, 74 patients received DCD grafts during the study period, and 1369 patients received DBD grafts. An initial comparison showed that many preoperative, prereperfusion, and donor variables in the DCD group differed significantly from those in the DBD group. Propensity matching was chosen so that adjustments could be made for the differences. A postmatching analysis showed that the preoperative, prereperfusion, and donor variables no longer differed between the 2 groups. The postreperfusion requirements for blood products and vasopressors, the posttransplant ventilation times, the incidence of posttransplant acute renal injury, and the 30-day and 1-year patient and graft survival rates were comparable between the 2 groups. However, patients receiving DCD grafts experienced significantly higher rates of hyperkalemia (33.8% versus 18.9%, P < 0.05) and postreperfusion syndrome (PRS; 25.7% versus 12.3%, P < 0.05). In conclusion, after adjustments for preoperative and prereperfusion risks via propensity matching, DCD grafts remained a risk factor for postreperfusion hyperkalemia and PRS. A prophylactic regimen aimed at decreasing postreperfusion hyperkalemia and PRS is recommended for the management of LT using DCD grafts.
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