Liver transplantation with donation after cardiac death donors: A comprehensive update

Harring, Theresa R.; Nguyen, Nancy; Cotton, Ronald T.; Guiteau, Jacfranz J.; Armas, Ismael A. Salas de; Líu, Hao; Goss, John A.; O’Mahony, Christine A.

doi:10.1016/j.jss.2012.04.044

Cited by 38 publications

(28 citation statements)

References 30 publications

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“…Its clinical course is often more severe and retransplantation required in a significant percentage (79,80). Analysis of the UNOS database of 2351 DCD-LT revealed a significantly decreased patient and graft survival with a 5-year graft survival rate of 56% (81). In this analysis CIT >8 h, donor age >50 years and donor WIT ≥ 20 min were identified as most relevant graft related factors for graft failure, but biliary complications were not specifically analyzed.…”

Section: Special Issues Of Dcdmentioning

confidence: 86%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Special Issues Of Dcdmentioning

confidence: 86%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

233

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“…To assess the outcomes of patients receiving DCD liver allografts, we analyzed the available previously published literature, including several single-center studies (Table 1) 6,[12][13][14][15][16][17][18][19] and large studies (Table 2) 7,[20][21][22][23][24][25] of national databases, to compare the outcomes of recipients who received DCD versus DBD donor livers and to better understand the risk factors for graft survival, loss, and failure.…”

Section: Current Practice and Outcome Of Donation After Cardiac Deathmentioning

confidence: 99%

“…Supporting this explanation, the DCD donors who were aged ≤ 45 years, had warm ischemia time (WIT) ≤ 15 min, and had CIT ≤ 10 h yielded livers that performed similarly to the livers of their DBD counterparts, according to national data. 22 which also demonstrated worse patient and allograft survival for DCD liver recipients.…”

Section: Single-center Studies Of Donation After Cardiac Death Liver mentioning

confidence: 99%

“…They identified 6 independent risk factors for graft failure, including 3 recipient risk factors, 2 donor factors, and an operative factor (Table 3). Harring and coworkers 22 observed that improved DCD liver transplant outcomes were associated with recipients who were aged < 50 years and had an international normalized ratio < 2 or albumin level > 3.5 g/dL. Therefore, several potential risk factors that predict graft loss have been identified.…”

Section: Risk Factors For Graft Survivalmentioning

confidence: 99%

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Untitled

2015

Exp Clin Transplant

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There are increasing numbers of patients on liver transplant waiting lists, and there is a continuing organ shortage crisis. Therefore, more centers and organ procurement organizations are developing protocols for donation after cardiac death. However, the effect of donation after cardiac death allografts on overall patient survival remains controversial, with some centers reporting equivalent patient posttransplant survival but many others indicating increased rates of complications, retransplant, utilization of resources, and death. Several potential risk factors that predict graft loss and recipient complications have been identified. To improve patient outcomes and reduce dropouts, experimental strategies that target both donors and recipients at various phases of the transplant process have focused on attenuating ischemia-reperfusion injury and have achieved encouraging results. In the present article, our goal is to provide an overview of the current status of, and recent advances in, liver transplant from donation after cardiac death, to better understand the risks and potential benefits of donation after cardiac death liver transplant.

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“…To date, risk factors for graft loss after DCD donation have primarily focused on donor, recipient and intraoperative factors that identify organs or recipients at increased risk for biliary complications or graft loss (4,7,10,(12)(13)(14)(15). Reported series have primarily identified either the magnitude of initial ischemic injury or individual donor susceptibility as factors associated with DCD liver graft failure.…”

Section: Introductionmentioning

confidence: 99%

Differential Rates of Ischemic Cholangiopathy and Graft Survival Associated With Induction Therapy in DCD Liver Transplantation

Halldorson

Bakthavatsalam

Montenovo

et al. 2015

American Journal of Transplantation

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Transplantation utilizing donation after circulatory death (DCD) donors is associated with ischemic cholangiopathy (IC) and graft loss. The University of Washington (UW) DCD experience totals 89 DCD liver transplants performed between 2003 and 2011. Overall outcome after DCD liver transplantation at UW demonstrates Kaplan-Meier estimated 5-year patient and graft survival rates of 81.6% and 75.6%, respectively, with the great majority of patient and graft losses occurring in the first-year posttransplant from IC. Our program has almost exclusively utilized either antithymocyte globulin (ATG) or basiliximab induction (86/ 89) for DCD liver transplantations. Analysis of the differential effect of induction agent on graft survival demonstrated graft survival of 96.9% at 1 year for ATG versus 75.9% for basiliximab (p ¼ 0.013). The improved survival did not appear to be from a lower rate of rejection (21.9% vs. 22.2%) but rather a differential rate of IC, 35.2% for basiliximab versus 12.5% for ATG (p ¼ 0.011). Multivariable analysis demonstrated induction agent to be independently associated with graft survival and IC free graft survival when analyzed against variables including donor age, fWIT, donor cold ischemia time and transplant era.

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Liver transplantation with donation after cardiac death donors: A comprehensive update

Cited by 38 publications

References 30 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Untitled

Differential Rates of Ischemic Cholangiopathy and Graft Survival Associated With Induction Therapy in DCD Liver Transplantation

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