Comparison of Postoperative Outcomes Between Donation After Circulatory Death and Donation After Brain Death Liver Transplantation Using the Comprehensive Complication Index

Kalisvaart, Marit; Haan, Jubi E. de; Polak, Wojciech; Metselaar, Herold J.; Wijnhoven, Bas P. L.; IJzermans, Jan N. M.; Jonge, Jeroen de

doi:10.1097/sla.0000000000002419

Cited by 57 publications

(59 citation statements)

References 33 publications

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“…Nevertheless, graft survival at 5 years was significantly lower in DCD recipients (54.4%) compared with DBD recipients (65.6%; P = 0.02) . Similar results were recently reported by a group in the Netherlands, evaluating DCD versus DBD LT from 2001 to 2015 (n = 115 and 326, respectively) . The authors of this series reported similar patient survival but lower graft survival in the DCD group compared with the DBD group at 5 years (60% versus 75%; P = 0.002) .…”

Section: Discussionsupporting

confidence: 86%

“…Similar results were recently reported by a group in the Netherlands, evaluating DCD versus DBD LT from 2001 to 2015 (n = 115 and 326, respectively) . The authors of this series reported similar patient survival but lower graft survival in the DCD group compared with the DBD group at 5 years (60% versus 75%; P = 0.002) . Additionally, this group evaluated the CCI as a measure of the entire burden of postoperative morbidity up to 6 months after LT.…”

Section: Discussionsupporting

confidence: 84%

“…Additionally, this group evaluated the CCI as a measure of the entire burden of postoperative morbidity up to 6 months after LT. They found a significantly higher median CCI at 6 months after LT in DCD recipients, and they additionally reported a higher number of patients undergoing retransplantation because of ischemic‐type biliary strictures in the DCD group . The DCD group in the currently presented study cohort reached a graft survival of 69.2% at 5 years, and there was no difference comparing the graft survival between the DCD, the LD, and the DBD group ( P = 0.24).…”

Section: Discussionmentioning

confidence: 67%

“…Furthermore, the comprehensive complication index (CCI) was calculated for all complications that occurred during hospital admission . The CCI is a validated metric system integrating all recorded complications into a formula, resulting in a score with a range of 0‐100 (CCI of 100 equals death) and is based on the Clavien‐Dindo classification …”

Section: Methodsmentioning

confidence: 99%

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Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

et al. 2018

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Because of the shortfall between the number of patients listed for liver transplantation (LT) and the available grafts, strategies to expand the donor pool have been developed. Donation after circulatory death (DCD) and living donor (LD) grafts are not universally used because of the concerns of graft failure, biliary complications, and donor risks. In order to overcome the barriers for the implementation of using all 3 types of grafts, we compared outcomes after LT of DCD, LD, and donation after brain death (DBD) grafts. Patients who received a LD, DCD, or DBD liver graft at the University of Toronto were included. Between January 2009 through April 2017, 1054 patients received a LT at our center. Of these, 77 patients received a DCD graft (DCD group); 271 received a LD graft (LD group); and 706 received a DBD graft (DBD group). Overall biliary complications were higher in the LD group (11.8%) compared with the DCD group (5.2%) and the DBD group (4.8%; P < 0.001). The 1‐, 3‐, and 5‐year graft survival rates were similar between the groups with 88.3%, 83.2%, and 69.2% in the DCD group versus 92.6%, 85.4%, and 84.7% in the LD group versus 90.2%, 84.2%, and 79.9% in the DBD group (P = 0.24). Furthermore, the 1‐, 3‐, and 5‐year patient survival was comparable, with 92.2%, 85.4%, and 71.6% in the DCD group versus 95.2%, 88.8%, and 88.8% in the LD group versus 93.1%, 87.5%, and 83% in the DBD group (P = 0.14). Multivariate Cox regression analysis revealed that the type of graft did not impact graft survival. In conclusion, DCD, LD, and DBD grafts have similar longterm graft survival rates. Increasing the use of LD and DCD grafts may improve access to LT without affecting graft survival rates. Liver Transplantation 24 779–789 2018 AASLD.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 67%

Section: Methodsmentioning

confidence: 99%

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Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

et al. 2018

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“…Similar to the study by Croome et al, (7) IC was defined as the presence of intrahepatic biliary strictures in the absence of hepatic artery thrombosis, which was confirmed by endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, or percutaneous transhepatic cholangiography. (17,18) Early allograft dysfunction (EAD) was defined as described by Olthoff et al (19)…”

Section: Definitionsmentioning

confidence: 99%

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

et al. 2019

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Use of donation after circulatory death (DCD) donor livers for transplantation has remained cautious in the United States. The aim of this study was to demonstrate the expansion of a DCD liver transplantation (LT) program with the use of extended criteria donor (ECD) DCD livers. After institutional review board approval, 135 consecutive DCD LTs were retrospectively studied. ECD DCD livers were defined as those with 1 of the following factors: donor age >50 years, donor body mass index >35 kg/m2, donor functional warm ischemia time >30 minutes, and donor liver macrosteatosis >30%. An optimization protocol was introduced in July 2011 to improve outcomes of DCD LT, which included thrombolytic donor flush and efforts to minimize ischemia times. The impact of this protocol on outcomes was evaluated in terms of graft loss, ischemic cholangiopathy (IC), and change in DCD LT volume. Of 135 consecutive DCD LTs, 62 were ECD DCDs. In total, 24 ECD DCD LTs were performed before (era 1) and 38 after the institution of optimization protocol (era 2), accounting for an increase in the use of ECD DCD livers from 39% to 52%. Overall outcomes of ECD DCD LT improved in era 2, with a significantly lower incidence of IC (5% versus 17% in era 1; P = 0.03) and better 1‐year graft survival (93% versus 75% in era 1; P = 0.07). Survival outcomes for ECD DCD LT in era 2 were comparable to matched deceased donor LT. With the expansion of the DCD donor pool, the number of DCD LTs performed at our center gradually increased in era 2 to account for >20% of the center's LT volume. In conclusion, with the optimization of perioperative conditions, ECD DCD livers can be successfully transplanted to expand the donor pool for LT.

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A Spectrofluorometric Method for Real‐Time Graft Assessment and Patient Monitoring

Huwyler

Eden²,

Binz

et al. 2023

Advanced Science

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Biomarkers are powerful clinical diagnostics and predictors of patient outcome. However, robust measurements often require time and expensive laboratory equipment, which is insufficient to track rapid changes and limits direct use in the operating room. Here, this study presents a portable spectrophotometric device for continuous real‐time measurements of fluorescent and non‐fluorescent biomarkers at the point of care. This study measures the mitochondrial damage biomarker flavin mononucleotide (FMN) in 26 extended criteria human liver grafts undergoing hypothermic oxygenated perfusion to guide clinical graft assessment. Real‐time data identified seven organs unsuitable for transplant that are discarded. The remaining grafts are transplanted and FMN values correlated with post‐transplant indicators of liver function and patient recovery. Further, this study shows how this device can be used to monitor dialysis patients by measuring creatinine in real‐time. Our approach provides a simple method to monitor biomarkers directly within biological fluids to improve organ assessment, patient care, and biomarker discovery.

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Comparison of Postoperative Outcomes Between Donation After Circulatory Death and Donation After Brain Death Liver Transplantation Using the Comprehensive Complication Index

Cited by 57 publications

References 33 publications

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

A Spectrofluorometric Method for Real‐Time Graft Assessment and Patient Monitoring

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