Does Donation After Cardiac Death Utilization Adversely Affect Hepatocellular Cancer Survival?

Khorsandi, Shirin Elizabeth; Yip, Vincent; Cortes, Mauricio; Jassem, Wayel; Quaglia, A.; O’Grady, John; Heneghan, Michael A.; Aluvihare, Varuna; Agarwal, Kosh; Menon, Krishna; Vilca‐Melendez, Hector; Prachalias, Andreas; Srinivasan, Parthi; Suddle, Abid; Rela, Mohamed; Heaton, Nigel

doi:10.1097/tp.0000000000001150

Cited by 34 publications

(34 citation statements)

References 38 publications

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“…DCD liver transplantation has grown exponentially in countries that have utilized this form of donation[3]. Institutionally, DCD donation accounts for over 20% of transplants performed[4]. However, reports of poor patient and graft survival highlight that this is an organ with risks.…”

Section: Introductionmentioning

confidence: 99%

Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

Khorsandi¹,

Giorgakis²,

Vilca‐Melendez³

et al. 2017

WJT

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AIMTo identify objective predictive factors for donor after cardiac death (DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index (DCD-RI) to help in prospective decision making on organ use.METHODSThe model included objective data from a single institute DCD database (2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.RESULTSDCD graft survival predictors were primary indication for transplant (P = 0.066), retransplantation (P = 0.176), MELD > 25 (P = 0.05), cold ischemia > 10 h (P = 0.292) and donor hepatectomy time > 60 min (P = 0.028). According to the calculated DCD-RI score three risk classes could be defined of low (DCD-RI < 1), standard (DCD-RI 2-4) and high risk (DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.CONCLUSIONThe DCD-RI score independently predicted graft loss (P < 0.001) and the DCD-RI class predicted graft survival (P < 0.001).

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Section: Introductionmentioning

confidence: 99%

Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

Khorsandi¹,

Giorgakis²,

Vilca‐Melendez³

et al. 2017

WJT

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“…From 2001 to 2014, 347 transplants for HCC were performed, with 26% from DCD donors and the remainder from DBD donors. Overall survival of DBD and DCD recipients was similar, and there were no cases of retransplantation for primary ischemic cholangiopathy in the DCD donor group …”

Section: Dcd Liver Transplantationmentioning

confidence: 89%

“…(13)(14)(15) Although evidence from retrospective series suggests that DCD donor OLT is associated with either equivalent or inferior short-term and longterm outcomes, recent reports suggest improving outcomes. ( (19) In the United States, DCD donor use has remained largely stable over the last decade representing approximately 4%-6% of liver transplants, with a mild increase in numbers in recent years (Fig. 1).…”

Section: Dcd Liver Transplantationmentioning

confidence: 99%

Donation after cardiac death in the hepatocellular carcinoma patient: Same indication?

Vining¹,

Ecker²,

Abt³

et al. 2017

Liver Transpl

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“…58,59 This concern was not confirmed by subsequent studies. [60][61][62] Likewise, the use of grafts from older donors was seen as a risk factor for post-LT HCC recurrence 63 and currently donor age is not by itself a limitation for donation in many centres worldwide. 64,65 The use of HCVinfected grafts in recipients with HCV has been proven safe.…”

Section: Use Of Marginal Graftsmentioning

confidence: 99%

Recent advances in liver transplantation for cancer: The future of transplant oncology

et al. 2019

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Liver transplantation is widely indicated as a curative treatment for selected patients with hepatocellular carcinoma. However, with recent therapeutic advances, as well as efforts to increase the donor pool, liver transplantation has been carefully expanded to patients with other primary or secondary malignancies in the liver. Cholangiocarcinoma, colorectal and neuroendocrine liver metastases, and hepatic epithelioid haemangioendothelioma are amongst the most relevant new indications. In this review we discuss the fundamental concepts of this ambitious undertaking, as well as the newest indications for liver transplantation, with a special focus on future perspectives within the recently established concept of transplant oncology.

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Does Donation After Cardiac Death Utilization Adversely Affect Hepatocellular Cancer Survival?

Abstract: Donor liver quality in terms of graft type (DCD) has no influence on cancer related survival in transplant for HCC (hazards ratio, 1.143; 95% confidence interval, 0.528-2.423; P = 0.752).

Cited by 34 publications

References 38 publications

Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

Donation after cardiac death in the hepatocellular carcinoma patient: Same indication?

Recent advances in liver transplantation for cancer: The future of transplant oncology

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