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BACKGROUND & AIMSDonation after circulatory death (DCD) in the UK has tripled in the last decade. However, outcomes following DCD liver transplantation are poorer than for brainstem death (DBD) liver transplants.This study examines whether a recipient to should accept a "poorer quality" DCD organ, or wait longer for a "better" DBD organ. METHODSSurvival following deceased donor liver transplantation performed between 2008 and 2015 was compared by Cox regression modelling to assess the impact on patient survival of accepting a DCD liver compared to deferring for a potential DBD transplant. RESULTS (23%) of the 3949 liver transplantations performed utilised DCD donors. Fiveyear transplant survival was poorer following DCD than DBD transplantation (69•1% (DCD) vs 78•3% (DBD); p <0•0001: adjusted hazard ratio [HR] = 1•65, 1•40 -1•94).Of the 5798 patients registered on the transplant list, 1325 (23%) died or were removed from the list without receiving a transplant. Patients who received DCD livers had a lower risk-adjusted hazard of death than those who remained on the waiting list for a potential DBD organ (adjusted HR 0•55, 0•47 -0•65). The greatest survival benefit was in those with the most advanced liver disease (adjusted HR 0•19 (0•07, 0•50). CONCLUSIONSAlthough DCD liver transplantation has poorer transplant outcomes, the individual's survival is enhanced by accepting a DCD offer particularly for patients with more severe liver disease. DCD liver transplantation improves overall survival for UK listed patients and should be encouraged.

Background There is renewed interest in the use of whole blood (WB) for the resuscitation of trauma patients. Platelet function in stored WB compared to platelet concentrates is not well established and was assessed in vitro in this study. Methods Leucocyte‐depleted cold‐stored WB (CS‐WB) was prepared using a Terumo WB‐SP Imuflex kit and held at 2–6°C alongside: (A) UK standard pooled platelets stored at 20–24°C (RT‐PLTS), (B) pooled platelets stored at 2–6°C (CS‐PLTS), and (C) platelet‐rich plasma produced using the Terumo kit (CS‐PRP), for 21 days. A series of in vitro assays were assessed platelet function. Results Platelet count was retained to 57 ± 14% of starting number at day 21 in CS‐WB. Over time, CS‐WB platelets become more activated, with increased CD62P expression (day 1: 7 ± 3.7% vs. day 21: 59 ± 17.1%) and annexin V binding (day 1: 2 ± 0.2% vs. day 21: 21 ± 15.1%). For comparison, 18.6 ± 6% of platelets in RT‐PLTS demonstrated CD62P expression at day 7, whereas annexin V binding in RT‐PLTS at day 7 was 2.6 ± 0.5%. Over storage, aggregatory response to agonists decreased in all arms. Functional platelet microparticles increased steadily in CS‐WB throughout storage. Conclusion During storage, platelet count reduced in CS‐WB, whereas CD62P expression and annexin V binding increased. This was accompanied by a reduced aggregatory response, although compared to 7‐day‐old RT‐PLTS, CS‐WB maintained a maximal response to agonists for longer, suggesting that the shelf life for CS‐WB can be considered for up to 21 days.

The data suggested that the pharmacokinetics of pranlukast are influenced by the time of dosing. Based on analysis of urinary 6 beta-hydroxycortisol excretion, there was no evidence that pranlukast modified the metabolic activity of cytochrome P-450 3A isoenzymes.

ObjectivesIncreased morbidity and mortality have been associated with weekend and night-time clinical activity. We sought to compare the outcomes of liver transplantation (LT) between weekdays and weekends or night-time and day-time to determine if ‘out-of-hours’ LT has acceptable results compared with ‘in-hours’.Design, setting and participantsWe conducted a retrospective analysis of patient outcomes for all 8816 adult, liver-only transplants (2000–2014) from the UK Transplant Registry.Outcome measuresOutcome measures were graft failure (loss of the graft with or without death) and transplant failure (either graft failure or death with a functioning graft) at 30 days, 1 year and 3 years post-transplantation. The association of these outcomes with weekend versus weekday and day versus night transplantation were explored, following the construction of a risk-adjusted Cox regression model.ResultsSimilar patient and donor characteristics were observed between weekend and weekday transplantation. Unadjusted graft failure estimates were 5.7% at 30 days, 10.4% at 1 year and 14.6% at 3 years; transplant failure estimates were 7.9%, 15.3% and 21.3% respectively.A risk-adjusted Cox regression model demonstrated a significantly lower adjusted HR (95% CI) of transplant failure for weekend transplant of 0.77 (0.66 to 0.91) within 30 days, 0.86 (0.77 to 0.97) within 1 year, 0.89 (0.81 to 0.99) within 3 years and for graft failure of 0.81 (0.67 to 0.97) within 30 days. For patients without transplant failure within 30 days, there was no weekend effect on transplant failure. Neither night-time procurement nor transplantation were associated with an increased hazard of transplant or graft failure.ConclusionsWeekend and night-time LT outcomes were non-inferior to weekday or day-time transplantation, and we observed a possible small beneficial effect of weekend transplantation. The structure of LT services in the UK delivers acceptable outcomes ‘out-of-hours’ and may offer wider lessons for weekend working structures.

Background and Objectives: Irradiation of red cell components is indicated for recipients at risk of transfusion-associated graft vs. host disease. Current technologies available comprise of a gamma (γ) or an x source of radiation. The benefits of x vs. γ include non-radioactivity and hence no decay of the source. We aimed to compare the effect of the two technologies on red cell component storage quality post-irradiation.Materials and Methods: Paired units of red cell concentrates (RCC), neonatal red cell splits (RCS), red cells for intra-uterine transfusion (IUT) or neonatal exchange transfusion (ExTx) were either γor x-irradiated. Units were sampled and tested for five storage parameters until the end of shelf life. Equivalence analysis of storage quality parameters was performed for pairs of the same components (RCC, RCS, IUT or ExTx) that were either γor x-irradiated.Results: Nearly all component comparisons studied showed equivalence between γ and x irradiation for haemolysis, ATP, 2,3-DPG, potassium release and lactate production. The exceptions found that were deemed non-equivalent were higher haemolysis with x irradiation for ExTx, lower 2,3-DPG with x irradiation for RCS irradiated early and higher ATP with x irradiation for IUT. However, these differences were considered not clinically significant. Conclusion:This study has demonstrated that a range of red cell components for use in different age groups are of acceptable quality following x irradiation, with only small differences deemed clinically insignificant in a few of the measured parameters.

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