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Safety and Outcomes in 100 Consecutive Donation After Circulatory Death Liver Transplants Using a Protocol That
H Bohorquez1,2, J B Seal1,2, A J Cohen1,2
1Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
Insights
Thrombolytic therapy improves outcomes for liver transplantation using livers from donation after circulatory death (DCD) donors. This approach makes DCD liver transplantation (LT) survival rates comparable to those from donation after brain death (DBD) donors.
Area of Science:
- Hepatology and Transplant Surgery
- Organ Donation and Transplantation
Background:
- Donation after circulatory death (DCD) liver transplantation (LT) has historically been associated with inferior graft survival and higher complication rates compared to donation after brain death (DBD) LT.
- A significant concern with DCD LT is the increased risk of ischemic-type biliary lesions (ITBL).
Purpose of the Study:
- To evaluate the impact of a specific protocol including thrombolytic therapy on DCD LT outcomes.
- To compare the outcomes of DCD LT performed with this protocol (late DCD) against historical DCD LT (early DCD) and standard DBD LT.
Main Methods:
- A retrospective analysis comparing 100 consecutive DCD LT cases using a thrombolytic therapy protocol (late DCD group) with 38 historical early DCD LT cases and 435 DBD LT cases.
- Graft survival, patient survival, re-transplantation rates, and incidence of ITBL were analyzed across the three groups.
Main Results:
- Late DCD LT demonstrated significantly improved 1- and 3-year graft survival rates compared to early DCD LT (92% vs. 76.3% and 91.4% vs. 73.7%, respectively).
- Graft survival rates in the late DCD group were comparable to the DBD group (92% vs. 93.3% and 91.4% vs. 88.2%).
- Re-transplantation rates were markedly lower in the late DCD group (1%) compared to the early DCD group (18.4%), and ITBL incidence was also reduced and manageable in the late DCD group.
Conclusions:
- Implementing a protocol that includes thrombolytic therapy significantly enhances graft survival and reduces complications in DCD liver transplantation.
- This protocol renders DCD LT outcomes, including patient and graft survival, comparable to those achieved with DBD LT.
- Thrombolytic therapy represents a valuable strategy to improve the utilization and success of DCD liver grafts.
Abstract:
Donation after circulatory death (DCD) liver transplantation (LT) reportedly yields inferior survival and increased complication rates compared with donation after brain death (DBD). We compare 100 consecutive DCD LT using a protocol that includes thrombolytic therapy (late DCD group) to an historical DCD group (early DCD group n = 38) and a cohort of DBD LT recipients (DBD group n = 435). Late DCD LT recipients had better 1- and 3-year graft survival rates than early DCD LT recipients (92% vs. 76.3%, p = 0.03 and 91.4% vs. 73.7%, p = 0.01). Late DCD graft survival rates were comparable to those of the DBD group (92% vs. 93.3%, p = 0.24 and 91.4% vs. 88.2%, p = 0.62). Re-transplantation occurred in 18.4% versus 1% for the early and late DCD groups, respectively (p = 0.001). Patient survival was similar in all three groups. Ischemic-type biliary lesions (ITBL) occurred in 5%, 3%, and 0.2% for early DCD, late DCD, and DBD groups, respectively, but unlike in the early DCD group, in the late DCD group ITBL was endoscopically managed and resolved in each case. Using a protocol that includes a thrombolytic therapy, DCD LT yielded patient and graft survival rates comparable to DBD LT.
