Current status and recent advances of liver transplantation from donation after cardiac death

Perera, M Thamara P R; Bramhall, Simon R.

doi:10.4240/wjgs.v3.i11.167

Cited by 13 publications

(3 citation statements)

References 76 publications

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“…Of these, two major predictors for graft loss were receiving a liver transplant due to the hepatitis C virus and receiving the liver organ from a nonheart‐beating donor. Both of these factors have previously been reported to have an association with graft loss . However, presence of DM in the donor was also found to independently predict graft loss in our study.…”

Section: Discussionmentioning

confidence: 72%

The impact of type 2 diabetes and obesity on the long‐term outcomes of more than 85 000 liver transplant recipients in the US

Younossi

Stepanova

Saab

et al. 2014

Aliment Pharmacol Ther

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Summary Background Type 2 diabetes is known to negatively impact the outcome of chronic liver disease. Aim To evaluate the impact of diabetes on the outcomes of liver transplants (LT). Methods Study cohort included adults (>18 years) who received LT in the US between 1994 and 2013 (The Scientific Registry of Transplant Recipients). Pre‐ and post‐transplant diabetes was recorded in patients with mortality follow‐up. Results We included 85 194 liver transplant recipients. Of those, 11.2% had history of pre‐transplant diabetes. The most common indications for liver transplant were hepatitis C (36.4%), alcohol‐related liver disease (20.6%), primary liver malignancy of unspecified aetiology (14.7%), cryptogenic cirrhosis (8.0%), hepatitis B (4.6%) and non‐alcoholic steatohepatitis (3.9%). A total of 96.5% transplants were from deceased donors, and 7.9% donors had history of diabetes. During an average 6.5 years of follow‐up, 31.3% recipients died and 8.8% had a graft failure. In multivariate survival analysis [at least 5 years of cohort follow‐up (N = 35 870)], after adjustment for age, ethnicity, insurance type, history of chronic diseases, HCV infection and noncompliance, independent predictors of recipient mortality included the presence of pre‐transplant diabetes [adjusted hazard ratio (95%CI) = 1.21 (1.12–1.30)] and developing diabetes post‐transplant [1.06 (1.02–1.11)]. Donor's history of diabetes was also independently associated with higher mortality [1.10 (1.02–1.19)]. Furthermore, donor's history of diabetes was also associated with an increased the risk of liver graft failure [1.35 (1.24–1.47)]. Conclusions Presence of type 2 diabetes pre‐ and post‐transplant, as well as presence of type 2 diabetes in the donors, are all associated with an increased risk of adverse post‐transplant outcomes.

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Section: Discussionmentioning

confidence: 72%

The impact of type 2 diabetes and obesity on the long‐term outcomes of more than 85 000 liver transplant recipients in the US

Younossi

Stepanova

Saab

et al. 2014

Aliment Pharmacol Ther

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“…In 2000, type V was included, in which the critical patient's heart stops unexpectedly; this type was also categorized as uncontrolled DCD. ( 2 , 7 - 9 ) Table 1 shows the different categories of this classification system.…”

Section: Introductionmentioning

confidence: 99%

Analysis of knowledge of the general population and health professionals on organ donation after cardiac death

Bedenko

Nisihara

Yokoi

et al. 2016

Revista Brasileira De Terapia Intensiva

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ObjectiveTo evaluate the knowledge and acceptance of the public and professionals working in intensive care units regarding organ donation after cardiac death.MethodsThe three hospitals with the most brain death notifications in Curitiba were selected, and two groups of respondents were established for application of the same questionnaire: the general public (i.e., visitors of patients in intensive care units) and health professionals working in the same intensive care unit. The questionnaire contained questions concerning demographics, intention to donate organs and knowledge of current legislation regarding brain death and donation after cardiac death.ResultsIn total, 543 questionnaires were collected, including 442 from family members and 101 from health professionals. There was a predominance of women and Catholics in both groups. More females intended to donate. Health professionals performed better in the knowledge comparison. The intention to donate organs was significantly higher in the health professionals group (p = 0.01). There was no significant difference in the intention to donate in terms of education level or income. There was a greater acceptance of donation after uncontrolled cardiac death among Catholics than among evangelicals (p < 0.001).ConclusionMost of the general population intended to donate, with greater intentions expressed by females. Education and income did not affect the decision. The type of transplant that used a donation after uncontrolled cardiac death was not well accepted in the study population, indicating the need for more clarification for its use in our setting.

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“…11 Subsequent work investigating this degree of graft failure suggested that DCD livers are injured by prolonged warm ischemic time due to the donation process, are more susceptible to postmortem clot formation, and have greater ischemic insult when compared to DBD donor grafts. 12 Further meta-analyses have suggested that DCD liver transplant recipients are also at a higher risk of developing ischemic cholangiopathy, further increasing the risk of graft failure and need for retransplantation. 13 Despite these complications, DCD livers provide otherwise unavailable organs and have been shown to reduce wait-list mortality and provide a definite survival benefit in patients with a high acuity of illness.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Postreperfusion Hyperfibrinolysis in Liver Transplantation by Donor Type and Observed Treatment Strategies

Krom

Welsby

Fuller

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Hyperfibrinolysis is a possible complication during liver transplantation, particularly immediately after reperfusion. METHODS: We performed a retrospective study to examine the incidence, treatment, and resolution of postreperfusion hyperfibrinolysis in patients undergoing liver transplantation at Duke University Hospital from 2015 to 2020. RESULTS: Out of 535 patients undergoing liver transplantation, 21 or 3.9%, 95% CI (2.5–5.9), had hyperfibrinolysis after reperfusion. Hyperfibrinolysis occurred in 16 of 511 (3.1%) patients receiving livers from DBD donors, 5 of 18 (27.8%) patients receiving livers from donation after circulatory death (DCD) donors, and 0 of 6 (0.0%) patients receiving livers from living donors. Fibrinolysis was treated with cryoprecipitate (12/21), a combination of cryoprecipitate and tranexamic acid (3/21), or neither (6/21) and resolved within several hours in all cases. CONCLUSIONS: Anesthesiologists should be aware of the possibility of postreperfusion hyperfibrinolysis in liver transplantation, particularly with DCD donors, and may consider treatment with cryoprecipitate or tranexamic acid. Further work is needed to identify any potential differences, such as faster resolution of fibrinolysis, between different treatment modalities.

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Current status and recent advances of liver transplantation from donation after cardiac death

Cited by 13 publications

References 76 publications

The impact of type 2 diabetes and obesity on the long‐term outcomes of more than 85 000 liver transplant recipients in the US

The impact of type 2 diabetes and obesity on the long‐term outcomes of more than 85 000 liver transplant recipients in the US

Analysis of knowledge of the general population and health professionals on organ donation after cardiac death

Incidence of Postreperfusion Hyperfibrinolysis in Liver Transplantation by Donor Type and Observed Treatment Strategies

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