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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
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Evaluation of Liver Graft Donation After Euthanasia
Marjolein van Reeven1, Nicholas Gilbo2,3, Diethard Monbaliu2,3
1Division of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
JAMA Surgery
|August 11, 2020
Summary
Organ donation after euthanasia, known as donation after circulatory death type V (DCD-V), shows comparable liver transplant outcomes to donation after circulatory death type III (DCD-III). This suggests DCD-V grafts are a viable option for expanding the donor pool.
Area of Science:
- Transplantation immunology and organ viability
- Graft survival and recipient outcomes
- Organ donor pool expansion strategies
Background:
- Organ donation after euthanasia (donation after circulatory death type V [DCD-V]) is an underutilized source of grafts.
- Assessing the outcomes of liver transplants (LTs) using DCD-V grafts is crucial for validating this donation pathway.
- Comparison with established donation methods, such as donation after circulatory death type III (DCD-III), is essential.
Purpose of the Study:
- To evaluate the outcomes of liver transplants (LTs) utilizing DCD-V grafts.
- To compare DCD-V graft LT outcomes with those from DCD-III grafts.
- To determine the viability and safety of DCD-V grafts in liver transplantation.
Main Methods:
- A retrospective, multicenter cohort study analyzed LT data from the Netherlands and Belgium.
- Included were LTs performed with DCD-V grafts (September 2012/January 2005 – July 1, 2018) and a comparative cohort of DCD-III grafts.
- Recipient and graft survival rates were tracked for at least 1 year post-LT, alongside postoperative complications.
Main Results:
- Recipient survival at 1, 3, and 5 years for DCD-V grafts was 87%, 73%, and 66%, respectively.
- Graft survival at 1, 3, and 5 years for DCD-V grafts was 74%, 61%, and 57%, respectively.
- No statistically significant differences in survival rates or postoperative complications (e.g., early allograft dysfunction, biliary strictures) were observed between DCD-V and DCD-III cohorts.
Conclusions:
- Liver transplants using DCD-V grafts demonstrate comparable outcomes to those using DCD-III grafts.
- Grafts donated after euthanasia represent a justifiable option for increasing the organ donor supply.
- Optimal donor selection and logistical management are critical for maximizing the potential of high-risk DCD-V grafts.
